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General NPI Number Information
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NPI Number | 1134204001
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Entity Type | Organization
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Legal Business Name | MARK D NOWELL
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 310 OAK ST
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City | LIVINGSTON
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State | TN
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Zip | 38570-1729
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Country | US
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Telephone | 931-403-5180
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Fax | 931-403-5182
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | LIVINGSTON
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State | TN
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Zip | 38570-0009
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Country | US
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Telephone | 931-403-5180
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Fax | 931-403-5182
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Authorized Official
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Title or Position | MD OWNER
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Name | DR. MARK DEWAYNE NOWELL
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Credential | MD
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Telephone | 931-403-5180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 36071
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License Number State | TN
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